267

and imperfect summing up of the arguments in favour of the respiratory failure theory, wrote: "On comparing thephenomena in the case of these animals with those offatal chloroform narcosis in the human subject, it is atonce seen that they are not identical ; for while in the lattercase [in that of human beings], both in instances of moderateand concentrated doses, the heart is nearly always the first tosuccumb, in the former the heart is in almost every casethe last to die." Sir B. W. Richardson, while he supportsthe view now almost universally held that chlorine containingchloroform kills healthy animals by interfering with respira-tion, adds: "A little want of elasticity in the coronaryarteries, an undue tendency to contraction in them, a

deficiency of power from interstitial deposit in the muscularsubstance-any of these conditions is amply sufficient toaccount for death from the heart......" The writer whoseremarks we are criticising then proceeds to enforce his

opinion that safety lies in small doses. There have been

many " safe ways" of giving chloroform vaunted, but, alas,no diminution in the death-rate has at present shown itself.It is a "serious indictment " which we made, but one towhich we must adhere, that by far the majority of the deathsreported as due to chloroform are unnecessary and shouldnot occur. IE the sole work of the Hyderabad Commissionhad been to insist upon the grave responsibility resting uponthe chloroformist it would still have rendered yeoman servicein the cause of humanity.

_

PSEUDO-BULBAR PARALYSIS.

DR. W. S. COLMAN has recorded in Brain a case of this

interesting condition. The patient was a man aged forty-ninewho, a year before his admission to hospital, was noticedto drag his left leg in walking. This weakness passed offsufficiently to allow him to resume his occupation, but itrecurred and rendered him quite helpless. Six months laterthere was some difficulty with articulation, and a few monthslater difficulty in swallowing and a simultaneous affectionof the right leg occurred, rendering it as useless as the left.There was also an alteration in his mental condition, so thathis laughter and tears were alike uncontrolled, but there wereno hallucinations and no true aphasic difficulties. When hecame under observation he was in this peculiar psychicalstate, ready to laugh or cry on the slightest provocation. He

complained of loss of memory and he was dull and confused,and his articulation was very imperfect. The face, arm, andleg muscles were all weak, the weakness being more markedon the right side than on the left. The knee-jerks wereexaggerated and ankle clonlls was present on both sidesand the jaw-jerk was also present. The tongue could

only be protruded as far as the lips. There was no

obvious wasting of it and no fibrillary twitching. Themovements of the soft palate were impaired, and theyafterwards became completely abolished. There was no

sensory impairment. The patient died from bronchitis and atthe necropsy the vessels at the base of the brain were foundto be atheromatous. Degenerated fibres separated by normalbundles were found in both internal capsules, and in the rightone was a patch containing hsematoidin crystals, evidentlythe remains of an old hæmorrhage. Many of the smallarteries in the neighbourhood were completely thrombosed.Descending degenerations could be traced throughout thewhole length of the cord in the crossed pyramidal tracts andas low as the third dorsal root in the direct pyramidal tracts.The cells of the hypoglossal nuclei and of the anterior hornswere not diminished in number or changed in appearance.The case is an interesting one, as showing how closely sucha condition simulates bulbar palsy. The same close resem-blance has been evident in similar cases recorded by Barlow,

1 Referring to Dr. Sansom’s experiments published in THE LANCET,May 11th, 1861, in which he found the heart’s action persisted in thelower animals after respiratory failure.

Lepine, Hughlings Jackson and Taylor, Ross, and others,and, as Dr. Colman points out, it must always be difficult,although we would hardly admit impossible, to diagnose theone condition from the other. The three points whichDr. Colman emphasises as important in diagnosis will, wethink, generally be found sufficient. These are the usuallyasymmetrical nature of the limb affection in the cases ofdouble hemiplegia, the absence of any marked wasting ofthe tongue, and the preservation of its electrical excitability.

DENTISTRY IN FRANCE.

THE British Jourital of Dental Science draws attention tothe new regulations with regard to foreigners wishing topractise dentistry in France. Such will in future have to

pass the ordinary examinations and obtain the diploma indental surgery. Those who were already practising onJan. 1st, 1892, will benefit by the transitory arrangementsprovided under the new law. As our contemporary remarks,the condition of things is much the same as when theDentists Act was passed in England. The time willbe in the recollection of many when old practitionerscame up to London to obtain the newly instituted

diploma at the Royal College of Surgeons of England.At present a similar class of men in France are fur-

bishing up whatever they knew of anatomy and kindred

subjects. The series of examinations for the diploma com-menced last month at the Faculty of Medicine in Paris, andthe majority of the candidates were provincial dentists.A selection from the questions asked shows that the field is

tolerably wide, so extensive even as to include the com-

parative anatomy of the generative organs.

SLANDERING A MEDICAL MAN.

AT the recent Warwickshire assizes a case of much in-terest to medical men was tried. It was an action for slander

brought by Dr. Frederick Thorne of Leamington against Mr.C. T. Richardson, a retired Indian planter resident in thattown. Mr. Richardson had sustained a fracture of theclavicle in the hunting field-a bad fracture, such as hunting-field accidents are apt to produce. It was in the middle ofthe bone, and it was difficult to keep the ends in perfectapposition ; but Dr. Thorne treated the case on the ordinaryprinciples and tried one or two varieties of bandage, finallyapplying the figure of 8 bandage. The patient was veryirritable and impatient of bandages, saying that he wouldprefer a lump on the bone to the tight bandages. He becameso irritable that Dr. Thorne declined further attendance or

responsibility, and recommended that another medical manshould be asked to take charge of the case. Thereafterthe defendant spoke in disparaging terms of Dr. Thorne toseveral of Dr. Thorne’s patients, and Dr. Thorne felt it

necessary to bring this action. The defendant denied some

of the language attributed to him, but he said he had

suffered great pain, aggravated by a tendency to junglefever which he said Dr. Thorne did not treat. Mr.

Thomas Smith of St. Bartholomew’s Hospital gave evidencein support of the treatment, and said it was quite proper. Hesaid he would have done just the same, both as to bandagingand retiring from the case. Dr. Smith of Leamington, whencalled on, said he found the defendant ill, with a pulse of50. He did not suggest any improper treatment ; nor didMr. Oliver Pemberton of Birmingham, who said the resultwas excellent so far as the bone was concerned. In fact,the disparagement of Mr. Richardson was shown to be

entirely groundless. The judge pointed out that the state-ments, if made, were calculated to damage a professionalman’s reputation and ought not to have been made except onsubstantial grounds. The jury found for the plaintiff withJE25 damages. We are glad that Dr. Thorne took the caseinto court. It is most unreasonable for a patient to hold a

268

surgeon responsible for pain and to blame him for applying ithe most approved treatment, as Dr. Thorne did here, evenin the opinion of witnesses for the defence ; and when toimpatience and peevishness he adds slander which becomessown broadcast, it is high time to appeal to the law forredress. Dr. Thorne’s action, both in its surgical and ethicalaspects, will commend itself to all members of the professionand, indeed, to all reasonable persons.

DEMENTIA AND INCOÖRDINATION IN CHILDREN.

VR..J:)ûUCHAUD records in the ltevue lYeurotogique twocuriously interesting cases. The patients were brother andsister, one aged six and the other aged seven at the com-mencement of the illness. This began with a certain amountof intellectual weakness and incoördination in all four limbs.The gait was like a combination of the tabetic and cerebellar,but no paralytic symptoms were present and no nystagmus.The knee-jerk was absent in one patient and much diminishedin the other, but the superficial reflexes were retained, thespeech was slow but the articulation good, and the ex-

pression was always bright. The symptoms, both physicaland psychical, became gradually worse, the speech unin-telligible, and difficulty in chewing and swallowing wassuperadded. The sphincters became affected, and muscularrigidity became marked. The muscles wasted, but therewas no fibrillary twitching. Scoliosis gradually developed,and bedsores were the final stage of the illness. In the boymeningeal symptoms were present before death, but the girldied from marasmus and influenza. An examination of thecords revealed in one case sclerosis in both lateral columns,while in the brain there was an absence of medullated fibres.In the other case there was a similar condition in the cord.Otherwise the nervous structures showed no abnormality,although the anterior horn cells were perhaps reduced innumber.

THE DIFFUSION OF SMALL-POX.

WE give the facts as to small-pox in London in anothercolumn. The malady seems to have subsided completely inWest Ham. At Walsall there were last week but 2 cases,and 17 at Birmingham, with 4 deaths, and the sanitaryauthority now hope that the disease will shortly die out, atany rate for the present. Much space has been occupied in z,some of the Midland newspapers concerning the death of a ’,man in Coventry, who is held by the health officer to havebeen unvaccinated, but who is, on the other hand, stated by Ithe anti-vaccination party to have been primarily vaccinated.The latter party appear to be catching at straws. Stockportis not yet free from small-pox, cases having been recordedagain last week. There were 22 fresh attacks at Man-

chester, and 1 death ; whilst several other towns in Lan-cashire and many in Yorkshire had experience of the

disease, Middlesbrough having half a dozen cases. At Leith

the end of the first week of July found 49 cases in hospital,and this number decreased to 28 a fortnight later. The Coal-hill Hospital has been closed, only 10 new cases having cometo light in the fortnight. Over 7000 persons have been vac-inated at the public expense at a cost of some ;&600. Two Icases of small-pox were reported and isolated in Dublin lastweek.

OVARIOTOMY DURING PREGNANCY.

IN the re7aize de Tocologie et de Gynecologie 1 there is

an article by Dr. R. Condamin on the treatment of ovariantumours complicating pregnancy, with an account of twocases of the kind which had come under his notice. The

question discussed is at what period should ovariotomy beundertaken : should the operation be undertaken during preg-nancy as soon as the tumour has been detected, or not until

1 Vol. xxi., part 4,

after the confinement 2 Dr. Condamin’s two cases point tothe advantage of operating as soon as the tumour has beendiscovered. In one of them ovariotomy was not performedtill about three months after the confinement, and in thatcase the patient had become very ill before the opera-tion was undertaken, with great pain and high temperature.When the abdomen was opened the pedicle of the tumourwas found to be twisted six or eight times, and the appear-ance of the cyst wall here and there suggested that gangrenewas about to supervene. The patient recovered, but fromthe account given it is evident that her condition was duringpart of the time such as to cause anxiety. Dr. Condaminbelieves that the lax condition of the abdominal walls

naturally resulting after labour is an important factor infacilitating twisting of the pedicle when there happens tohave been an ovarian tumour complicating the pregnancy.In the other case related ovariotomy was undertaken atthe fifth month of pregnancy ; the operation was per-fectly simple and the after history uneventful. It is not.

however, expressly mentioned whether or not the patientwent her full time. Dr. Condamin refers also to the seriesof post-partum ovariotomies published by Dr. Aust Lawrencelast year, and he considers that an examination of the detailsof these cases strongly supports the conclusion to which hehas himself arrived-namely, that when an ovarian tumouris discovered during pregnancy there are no advantages-but,on the contrary, many serious disadvantages-in delay, andthat ovariotomy should be performed as soon as possible.We may add that this accords with the opinion generallyheld in England.

-

SHAM NURSES.

IT is reported that fashion, late but for once true in

taste, has begun by occasional ventures to appropriate theseemly nursing costume as part of her system of decoration.We need not be surprised at the preference thus expressed.Cleanly, simple, neat, but undemonstrative as it usually is,the dress of female attendants on the sick was not likely toescape entirely from the flattery of imitation. Neverthelesswe consider its exhibition at all times and places, and espe,cially its use by those who have no professional title to its use,to be an error and a folly. The nurse’s apron, cloak, andbonnet are as much her distinctive regimentals as militaryscarlet is the national guarantee of a soldier’s position.Wearing it we know exactly who and what she is, we cansomewhat gauge her character by her attire, and we cantrust her service ; but if any and every admirer of her comelydress may ignore its distinctive character we lose much morethan can be gained by a usurping fashion. The meaning isentirely gone. The casual wearer may be anyone-no merelyinnocent masquerader, not even the glorified jackdaw of thefable, a nameless attraction only, a person void of per-sonality, perhaps not insignificant, but certainly, in the indi-cations of her clothing, unreliable. It is to be hoped, forthe credit and continued usefulness of a class representativeof the highest womanhood and not less for our common

security against a mischievous deception, that every meanswhich public sense can employ will be used to baffle thisnew strategem of thoughtless or unscrupulous fancy.

THE TREATMENT OF INFANTILE TUBERCULOSISAND RACHITIS IN FRANCE.

AT the Congres de Bains de Mer, lately held at Boulogne,a note on the proceedings at which will be found in

another column of our present issue, an interesting accountwas given of the treatment of rachitis at the children’s

hospitals at Berck, at Arcachon, and at Banyuls-sur-Mer.The hospital at Berck is supported by the municipality ofParis, with payments for patients from other places ; and theother institutions exist by subscriptions, by payments from